Endocrine Abstracts

Introduction: Liver involvement is frequent in Turner’s syndrome (TS). We have shown that 35% TS women have elevated liver function tests (↑LFTs). Most common hepatic changes include steatosis and steatohepatitis; however, progression to advanced fibrosis and cirrhosis is reported. This study assessed a simple noninvasive test for liver fibrosis, FIB-4, which combines standard biochemical values (platelets, ALT, AST) and age in order to evaluate its diagnostic performance in TS.

Methods: From a total of 104 patients attending our dedicated adult TS-clinic, we selected cases corresponding to the following criteria: 1) laboratory assessments allowing FIB-4 calculation; 2) absence of heavy alcohol consumption; 3) absence of other liver comorbidities. Karyotype, clinical and metabolic data were collected. A FIB-4 >1.3 was used, as a validated cut-off of increased risk of advanced fibrosis. Comparisons between FIB-4, liver biopsy and noninvasive (serologic and morphologic) markers of fibrosis were performed.

Results: Fifty-nine women, including 26 with ↑LFTs had a FIB-4 evaluation. FIB-4 scores ranged between 0.24 and 3.03, median 0.68. In the ↑LFTs-group median was 0.84 (range 0.4–3.03). Strong correlations were found between FIB-4 and GGT (P=0.009), ALP (P=0.005), duration of ↑LFTs (P=0.002) and AST-Platelet-Ratio-Index (P=0.001). FIB-4 was >1.3 in 9 women, 7 with ↑LFTs. Of these, one (FIB-4 1.3), Fibroscan 8.9 kPa (>7 kPa suggestive of fibrosis, >11 kPa of cirrhosis) and MRCP showing poor intrahepatic filling. One (FIB-4 1.48) had a biopsy finding of periductal fibrosis and one (FIB-4 3.03) Fibroscan 30.1 kPa and biopsy showing cirrhosis. The other patients were referred for Fibroscan. Biopsy was performed in 3 women with normal FIB-4, but ↑LFTs: none of which demostrated fibrosis.

Conclusions: Comparison between FIB-4 and liver biopsy showed a high concordance, suggesting that FIB-4 may be a useful noninvasive tool to screen for significant fibrotic liver disease in TS women and exclude those who do not require biopsy.